Effectiveness of prophylaxis treatment in the acute febrile stage of febrile seizure in children under five years old

Objectives In children suffering from febrile seizure, the likelihood of recurrence seems to be high in the early hours following the first episodes in the absence of proper interventions. The present study was aimed at assessing and comparing the outcomes of different preventive interventions in the acute stage after febrile seizure in children. Materials & Methods This randomized clinical trial study was performed between September 2015 and September 2016. We enrolled patients aged between 6 and 60 months suffered from febrile seizure and referred to the Pediatric Emergency Department at Besat Hospital in Hamadan. The eligible patients were randomly assigned to the following four receive one of the following groups: group 1 (not receiving any anti-seizure drugs), group 2 (receiving a single dose of phenobarbital) on admission, group 3 (receiving a single dose of phenobarbital on admission continued until the fever is resolved), and group 4 (receiving diazepam until the disappearance of fever). Results: The study population consisted of 248 children. The recurrence rate of seizure in the acute stage was 4.84%. Also, the impact of diazepam and phenobarbital (either as a single dose or as continuous) on the prevention of febrile seizure recurrence in the acute stage has been established. None of the patients had febrile status epilepticus. Conclusion: Controlling seizures without prescribing anti-seizure drugs increases the risk for the recurrence of febrile seizure in the acute stage. Different drug regimens for controlling seizure, including diazepam and phenobarbital (as stat or maintenance), may play a similar role in preventing the occurrence of febrile seizure.

focal or occur more than once in 24 hours (1).
Despite the frequency of febrile seizures (2%-5%), there is no unanimity of opinion regarding management options (1,2,3,4). When a single FC or repetitive FC last more than 30 min without the recovery of the normal consciousness, a febrile status epilepticus occurs (5). Experimental studies performed in the 80s showed that the central nervous system (CNS) homeostasis was constitutively altered in the case of seizures lasting more than 30 min (6). In this regard, the literature suggests that short seizure duration may reduce CNS risk factors. On the other hand, further studies showed that a single epileptic event usually resolves within 2-5 min, while those critical events lasting more than 10-15 min show a higher risk and are not spontaneously resolved (7). Although this phenomenon is naturally benign, it may lead to severe anxiety among parents (8). Besides its benign nature, the high likelihood of some serious complications, such as status epilepticus and mesial temporal sclerosis, highlight the importance of the early management of febrile seizure (9).
In this regard, recurrent febrile seizure is primarily critical. Several factors have been identified to increase the risk for recurrent febrile seizure, including age less than one year at the time of the first seizure, family history of febrile seizure in relatives, low fever during seizure, and the occurrence of complex seizures (10,11). The optimal management of febrile seizure is mainly based on three steps, including 1) management of the patient at the time of seizure and status epilepticus, 2) management of the recurrence of febrile seizure in the early hours after seizure interruption, and 3) management of the recurrence of febrile seizure in the next febrile courses (12,13). In the first step, the treatment protocol is similar to the seizure conditions without fever. In subsequent steps, the early prevention of seizure can result in favorable outcomes. Due to the benign nature of this event, it is not necessary to follow an especial preventive or therapeutic protocol, except for those conditions with a high risk for recurrent episodes or stress in parents (14). Moreover, in the third step, two preventive approaches are now accepted, including intermittent treatment with Different drug regimens for controlling seizure, including diazepam and phenobarbital (as stat or maintenance), may play a similar role in preventing the occurrence of febrile seizure.  (15). In total, and according to some evidence, the likelihood of recurrence is high in the early hours in the absence of proper interventions (16). Furthermore, using various preventive interventions may lead to different outcomes in affected children. The present study was aimed at assessing and comparing the outcome of different preventive interventions in the early hours after febrile seizure. The aim of this study was to evaluate the effect of prophylaxis treatment in acute FC stage until fever subsides. In cases with the recurrence of seizure (regardless of the study group), phenobarbital as 10 mg/kg was administered IM followed by 2.5 mg/kg/12h

Materials & Methods
intramuscularly. In cases with status epilepticus (more than 30 minutes or two consecutive seizures with lack of consciousness among seizures lasting more than 30 minutes), the routine protocol for treating status epilepticus was followed. All the patients were evaluated with regard to the cause of fever. In cases with uncontrolled fever, acetaminophen (   and Salehi (27), but in the study by Agrawal (24) most patients had complex FC; this discrepancy could be due to geographical and race differences.
In the present study, the highest rate of recurrence